Osteoporosis Pathophysiology: Osteoporosis Presentation of the Disease

Osteoporosis Pathophysiology: Osteoporosis Presentation of the disease Osteoporosis is a disease in which the body fails to regenerate enough bone to replace the bone mass that is lost when the body reabsorbs the tissue as part of the natural cycle of bone regeneration. "Bone is living tissue, which is constantly being absorbed and replaced" (Osteoporosis, 2011, Mayo Clinic: Definition). "When you're young, your body makes new bone faster than it breaks down old bone and your bone mass increases.

Most people reach their peak bone mass by their early 20s" (Osteoporosis, 2011, Mayo Clinic: Causes). Initially, the disease may not present any symptoms for many years. Some patients do not know they have the condition until they experience an unexpected bone break after a minor trauma or during daily activities. Other symptoms include loss of height, back pain from degeneration of the bone of the vertebrae or stooped posture (Osteoporosis, 2011, Mayo Clinic: Causes).

Etiology Despite being widely viewed as a disease of old age, osteoporosis can manifest itself at any time. It can also manifest itself in both women and men, regardless of a patients' race or ethnicity. However, since women have less bone mass to begin with, osteoporosis is more commonly diagnosed in women (Osteoporosis, 2011, Mayo Clinic: Definition). The more bone mass someone has by their 20s, the less likely they are to develop osteoporosis.

But while genetics has an undeniable influence upon a person's likelihood of manifesting osteoporosis, a number of environmental factors can raise a person's risk of osteoporosis. Lowered levels of sex hormones, which occurs after menopause in women, means that older women are at an increased risk for osteoporosis although "men experience a gradual reduction in testosterone levels as they age" increasing their risk as well (Osteoporosis, 2011, Mayo Clinic: Definition). The earlier a woman experiences menopause, the greater her risk of manifesting the condition.

Women who experience amenorrhea due to anorexia nervosa or bulimia, malnutrition (low levels of calcium and other minerals are associated with osteoporosis); or certain kinds of cancer treatments like chemotherapy have a greater risk. Other, less common risk factors include an overactive thyroid or adrenal gland and weight loss surgeries which interfere with the absorption of vital nutrients (Osteoporosis, 2011, Mayo Clinic: Risk factors). Taking some medications like steroids increases a patient's risk.

"Long-term use of corticosteroid medications, such as prednisone and cortisone, interferes with the bone-rebuilding process" and medications used to treat depression, gastric reflux, and to prevent transplant rejection also increase the likelihood of developing osteoporosis (Osteoporosis, 2011, Mayo Clinic: Risk factors). However, perhaps the most critical risk factors are lifestyle factors. A lack of physical activities that promote rapid bone transfer like weight-bearing exercises and as tobacco and alcohol use are associated with developing osteoporosis.

Clinical manifestations At its end stages, the symptoms of osteoporosis like a hunched posture or hip or spine fractures after a minor trauma may be extremely obvious. But during the early stages, diagnosis usually requires a bone scan. Clinicians may engage in a form of 'pre-screening,' or identifying patients likely to be at risk because of the other medical conditions they are manifesting, genetic and lifestyle factors, and the medications they are currently taking. Diagnostic tests A bone density scan is the most common method of diagnosing osteoporosis.

A bone mass density (BMD) score of 2.5 SD or below the average value for premenopausal women warrants a diagnosis (Kanis 2002) "The same absolute value for BMD used in women can be used in men. The recommended site for diagnosis is the proximal femur with dual energy X-ray absorptiometry (DXA)" (Kanis 2002).

Management of the pathology Medical For younger patients in the early stages of the disease, management of the causes of the osteoporosis is essential, such as restoring the patient's normal menstrual cycles with appropriate diet; adjusting the patient's medications to reduce the risk of further bone loss; or establishing a normal endocrine balance of the patient's hormones. For patients at risk because of lifestyle factors such as inactivity, a program of weight-bearing activities may be prescribed.

Surgical No surgical treatment is specifically prescribed for osteoporosis, although due to complications from the disorder such as a hip fracture, surgical procedures may be warranted. Pharmaceutical Action: The most common pharmaceutical treatment for osteoporosis is calcium supplementation. If this is not effective, bisphosphonate drugs like Fosamax may be prescribed (Osteoporosis, 2011, Mayo Clinic: Treatment and drugs). Adverse effects: The most common side effects of bisphosphonates include nausea and other gastric conditions. Some women prefer the injectable form of the drugs for this reason.

In some patients, the use of bisphosphonate has been linked to stress fractures in the upper femur and jaw osteonecrosis (Osteoporosis, 2011, Mayo Clinic: Treatment and drugs). Most important nursing considerations: Treatment will vary depending on the severity of the osteoporosis, its cause, and the age and lifestyle of the patient. Virginia Henderson: Four unmet needs and cares Unmet needs "Avoid dangers in the environment and avoid injuring others:" (Virginia Henderson's need theory, 2012, Nursing Theories).

For an elderly patient, avoiding dangers in the environment may entail creating a housing configuration whereby the patient is unlikely to fall and injure herself (through the use of railings by stairs and in the shower, for example); for a younger patient it may require additional weight-bearing activities and exercise.